Myths about Menopause

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Menopause is a natural process that signals the end of a woman’s fertility cycle. Knowing what to expect, and understanding the truth behind some common menopause myths, can make the transition easier.

ThinkstockPhotos-532109298Myth: Menopause happens immediately after a woman has had her last menstrual period.

Menopause, for most women, is a gradual process, and only fully happens a year after the last menstrual period. Symptoms may occur slowly, peak and then go away gradually as a woman goes through menopause.

Myth: Not all women experience perimenopause or menopause symptoms. Continue reading.


Moms, It’s Okay to Ask for Help

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According to Governor Snyder’s declaration of the month of May as Postpartum Depression Month, as well as Mental Health Month, roughly 20 percent of families with newborns, or 23,000 Michigan women and their families, are affected by postpartum depression each year. Many more cases go unreported or undetected.

Tired Mother Suffering From Post Natal DepressionPostpartum or perinatal mood changes can be difficult to detect. Becoming a mom is a big change, and some emotional changes are expected to go along with the transition. Some indicators of a more serious problem can include:

  • Sleep changes unrelated to your baby’s sleep pattern
  • Feelings of guilt or inadequacy
  • Obsessive, morbid or self-harmful thoughts
  • Crying, or feelings of anxiety without something to be sad or anxious over
  • Changes in appetite

Perinatal mood changes are common, but your health care provider can’t help if they don’t know you need help. It’s important to speak up if you need help. New mothers have a lot of work to do, and it can be hard to pause and take care of yourself – but “it’s impossible to pour from an empty cup.” Taking care of yourself will help you take better care of your family.

We’re committed to breaking down some of the stigma surrounding mental health concerns. It is possible to feel joy that your baby is here, but simultaneously be struggling with your mood. One does not exclude the other. If you feel like you’re struggling, please reach out for help.

Rausch_Jessica-FNP-126Family Nurse Practitioner Jessica Rausch, F.N.P., sees patients at MidMichigan Obstetrics & Gynecology in Midland. To make an appointment, contact her office at (989) 631-6730.



Exercising During Pregnancy: Is It Safe?

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We all know that exercise is recommended and comes with great health benefits. With warm weather just around the corner, it’s even more motivation to get outside and take a walk, go for a run or play an outdoor sport. But is it safe to exercise if you’re pregnant?

ThinkstockPhotos-475690098First and foremost, it’s important that you check with your health care provider before beginning any type of exercise routine, since every woman and every pregnancy is different. It’s also important to make sure you are well hydrated before engaging in any type of exercise.

If you do get the okay from your physician to exercise, there are many different workout options to choose from, including: Continue reading.


Reduce Your Risk of Cervical Cancer

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January is Cervical Health Awareness Month, and there’s a lot that women can do to help prevent cervical cancer.

ThinkstockPhotos-489302480Each year, more than 11,000 women in the United States get cervical cancer. One of the major causes of this cancer is Human papillomavirus, or HPV.

HPV is a very common infection that spreads through sexual activity. About 79 million Americans currently have HPV, but many of them don’t even know that they’re infected. That’s because HPV generally doesn’t have any symptoms. In fact, in many cases, the body can fight off HPV naturally, but in serious cases, the body is at risk for serious complications. Continue reading.


FAQ: Mammograms and Breast Imaging

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When it comes to women’s breast health, screening mammograms and more, all of the information that’s available can become confusing. In honor of Breast Cancer Awareness Month this October, Lindsay Zeeb, M.D., answers some of the most common questions surrounding mammography and breast imaging.

I have no family history of breast cancer and am not at high risk. I don’t need a screening mammogram every year, right?

75 percent of breast cancers occur in women who do not have a significant family history and are not considered high risk.

thinkstockphotos-497410378I heard a news story that I don’t need a mammogram every year until I’m 50. When should I be screened?

News media tends to take a “one-liner” and develop a news story out of it. The truth is that everyone (including the American Cancer Society and the United States Preventive Services Task Force) agrees that the most amount of lives saved from breast cancer is with yearly mammography for women ages 40 and older. Screening mammography only works if we catch the breast cancer early while there is a high chance of cure. Every one out of six breast cancers occur in women ages 40 to 49. In women who are 50 years and older, skipping a mammogram every other year would result in 30 percent of missed cancers.

I am 70 years old. Should I continue to have mammograms? Continue reading.


Dispelling the Myths about Mammograms

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In honor of Breast Cancer Awareness Month this October, Diagnostic Radiologist Lindsay Zeeb, M.D., addresses some of the common myths surrounding mammography.

Myth: Breast cancer doesn’t run in my family, so I don’t need a mammogram and I won’t get breast cancer.

thinkstockphotos-86516769Fact: 90% of women diagnosed with breast cancer have no family history of the disease. The American College of Radiology recommends a screening mammogram yearly for women over the age of 40, regardless of symptoms or family history. Early detection of breast cancer is crucial. This increases the chance of finding a smaller cancer, which has a higher chance of cure. Waiting until you have symptoms such as a palpable lump or discharge increases the chance for cancer spreading, and it may be incurable. Early stage cancers have a five-year cure rate of 99%, compared to later staged cancers, which have a cure rate of 24%.

Myth: I had a normal mammogram last year, so I don’t need one this year.

Fact: Having a normal mammogram one year does not guarantee that a cancer will not develop or become apparent on a mammogram the following year. Skipping a mammogram every other year has been shown to “miss” up to 30% of cancers, even in women aged 50 and older.

Myth: A mammogram will expose me to unnecessary radiation. Continue reading.


Reduce your Risk of Gynecologic Cancers

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September is Gynecologic Cancer Awareness Month. The term ‘gynecologic cancer’ encompasses five types of cancer – vulvar, vaginal, cervical, uterine or endometrial and ovarian. Unfortunately, we only have a screening tool for cervical cancer at this time, the Pap smear.

Many people have heard that there are new guidelines surrounding when women need Pap smears, and that not all women need a Pap smear every year. This is, indeed, true – but the option to space testing out needs to be evaluated on an individual basis. As with many guidelines, the newest recommendations surrounding Pap smears are not “one size fits all” and change based on history, age and habits.

Additionally, even if women do not need an annual Pap smear, an annual exam is still recommended. Your annual women’s exam consists of much more than cervical cancer screening! While there are not tests done specifically to test for the other four gynecologic cancers, many of the conversations that happen at your annual exam can clue your provider in to signs or symptoms you may be having. When your history and physical exam are considered together, your provider may recommend further testing to look into the other four gynecologic cancers. Depending on age, annual exams may also lead to detection of breast and colon cancer.

Many women feel like they do not need to be seen unless they are having an issue, but a wellness visit is just as important as a problem visit.

As always, prevention is the most effective medicine. The risks of gynecologic cancers, generally, can be reduced by quitting smoking, practicing safe sex and getting the HPV vaccination.

Rausch_Jessica-FNP-126Nurse Practitioner Jessica Rausch, F.N.P., is a nurse practitioner who sees patients at MidMichigan Obstetrics & Gynecology. She specializes in obstetrics and gynecology. Jessica received her nursing degree from Saginaw Valley State University and her Master of Science in Nursing degree from the University of Michigan.



3-D Tomosynthesis Mammography

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3-D tomosynthesis mammography is a revolutionary state-of-the-art technology that allows radiologists to “see” through the breast tissue, layer by layer, more closely by minimizing overlapping tissue. During a 3-D mammogram, multiple low dose images are acquired at different angles. This provides multiple slices through the breast tissue for radiologists to view, similar to flipping through the pages of a book.

This new technology has been proven to be more accurate and beneficial for all patients regardless of age or breast density. I believe that in the future, this will be the breast screening study of choice for all patients and will be widely adopted. The benefits of this technology include:

Earlier detection: 3-D mammography has been proven to detect more cancers at an earlier stage.

Fewer callbacks: 3-D mammography helps distinguish normal overlapping tissue from masses, leading to fewer callbacks and less anxiety.

Better visualization: Radiologists can see the size, shape and location of an abnormality.

The extra images will take just a few seconds more per view while in compression. We do still need compression of the breast tissue to help reduce motion artifact, radiation dose and to provide clearer images.

We continue to perform standard 2-D mammogram images in addition to the 3-D for comparison to previous years and to evaluate calcifications. Calcifications are better assessed on the 2-D images.

As in any exam using radiation, radiation dose varies from person to person. A 3-D mammogram does have a slightly higher dose than a standard mammogram, but is within the allowable limits set by the Food and Drug Administration (FDA).

At this time, some insurance providers do not cover a 3-D mammogram. As there are multiple insurance carriers and plans, I encourage patients to check with their individual health plans for coverage details. Even if your insurance company does not cover a 3-D mammogram, the most you would be billed for the 3-D portion of the exam is currently $100. It may be helpful to provide the CPT code listed below to your insurance carrier to determine coverage.

Tomosynthesis when performed with a screening mammogram, CPT77063

Tomosynthesis when performed with a diagnostic mammogram, CPT G0202

MidMichigan Health is currently offering 3-D mammography at the Center for Women’s Health  on the campus of MidMichigan Medical Center – Midland with plans to expand this service to other locations soon. To schedule your mammogram, contact MidMichigan Health at (888) 367-2778.

Zeeb_Lindsay_MD_126Lindsay Zeeb, M.D., board-certified diagnostic radiologist, is the medical director of Breast Imaging and the Center for Women’s Health at MidMichigan Medical Center – Midland. As a breast imaging specialist, Dr. Zeeb reads and interprets the images produced by mammography, ultrasound and magnetic resonance imaging (MRI), then makes recommendations for further diagnostic testing and treatment. She also conducts image-guided breast biopsies. She believes that patients play a pivotal role in the battle against breast cancer and that keeping up with yearly mammograms can help diagnose cancer early, when it is most curable.


The Importance of Understanding Your Breast Density

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In June 2015, Michigan became the 21st state to enact breast density notification legislation. This requires that mammogram facilities inform patients if they have dense breast tissue on mammography. This will be done in the form of a letter. At MidMichigan Health, we include this in the result letter that we send out for every mammography patient. It is also included in the radiology report that is sent to your health care provider.

What is breast density?

Breasts are made up of a mixture of fibrous and glandular tissue as well as fat. Fibrous and glandular tissue are displayed as white on a mammogram. Fat shows up as black. Some women have denser breast tissue than others; this is not completely understood. In some women, breast density may decrease with age. Having dense breasts is not abnormal – 50 percent of women have dense breasts. Breast Density

Breast density is separated into four categories, determined by the radiologist interpreting your mammogram. The image at the right shows an image of what these are and their assigned categories (almost entirely fat (a), scattered fibroglandular densities (b), heterogeneously dense (c) and extremely dense (d)).

The image to the left shows aBreast Density 2 distribution of breast density for women in the United States. Ten percent of women have almost entirely fatty breasts and 10 percent have extremely dense breasts. Eighty percent are classed in one of the middle two categories.


Why is this important?

Studies have shown that dense breasts may increase the risk of developing a breast cancer. Also, masses, which can be benign or malignant, show up as white on a mammogram. Therefore, the dense tissue may obscure a small mass.

Screening mammography is still the only medical imaging screening test proven to reduce breast cancer deaths. Many cancers are seen on a mammogram even in patients with dense breast tissue. However, studies have shown that small cancers can be detected with additional supplemental exams such as with ultrasound or MRI, which cannot be seen on a mammogram. Both MRI and ultrasound show more findings that are not cancer, which may lead to additional testing and unnecessary biopsies. Also, the cost of these studies may not be covered by insurance. In my experience, ultrasound is the more frequently covered exam, but I encourage you to check with your individual health insurance provider for specific details.

If you do not have dense breasts, the recommendation is for a screening mammogram on an annual basis starting at the age of 40. Not having dense breasts should not provide a false sense of security or mean that you will not develop a breast cancer or do not need screening. Other factors may still place you at increased risk for breast cancer, including but not limited to a family history of the disease, previous breast biopsies and previous chest radiation.

If you do have dense breasts and are thinking of having additional screening studies, please talk to your health care provider. You can decide together which, if any, additional screening exams are right for you.

MidMichigan Health offers screening breast ultrasound and breast MRI in addition to a screening mammogram. Ultrasound and MRI are not intended to replace the annual mammogram. Increased sensitivity in breast cancer detection has only been proven in use with a current mammogram. As I said previously, many cancers are still visible on mammograms even in patients with dense breast tissue.

For more information on breast density and breast cancer screening, visit or

To schedule a screening mammogram, breast ultrasound or breast MRI, contact MidMichigan -Health at (888) 367-2778.

Zeeb_Lindsay_MD_126Lindsay Zeeb, M.D., board-certified diagnostic radiologist, is the medical director of Breast Imaging and the Center for Women’s Health at MidMichigan Medical Center – Midland. As a breast imaging specialist, Dr. Zeeb reads and interprets the images produced by mammography, ultrasound and magnetic resonance imaging (MRI), then makes recommendations for further diagnostic testing and treatment. She also conducts image-guided breast biopsies. She believes that patients play a pivotal role in the battle against breast cancer and that keeping up with yearly mammograms can help diagnose cancer early, when it is most curable.




The Latest Update on the Zika Virus

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As our knowledge of the Zika virus expands, recommendations for patients are also evolving. In the past week, the first cases of mosquito-borne transmission of Zika were documented in the United States. In addition, the Centers for Disease Control and Prevention (CDC) have issued an updated travel advisory for pregnant women. Obstetrician and Gynecologist Shawna Ruple, M.D., summarizes important information below. If you are looking for ways to help, consider writing a letter or contacting our state and federal government to rally for Zika virus research funding. If you have questions or concerns, contact your health care provider. Information continues to evolve rapidly, and further updates will be posted as information becomes available.

Zika virus and pregnancy

  • Zika virus can pass from a pregnant woman to her fetus during pregnancy.
  • Infection in pregnancy is a cause of microcephaly and severe brain defects. In addition, Zika can result in eye defects, hearing loss, impaired fetal growth and intrauterine death.
  • Pregnant women should not travel to areas affected by the Zika virus. If travel is unavoidable, women must protect themselves from mosquito bites.
    • Wear long-sleeved shirts and long pants.
    • Stay and sleep in places with door and window screens to keep mosquitoes outside. Consider sleeping under a mosquito bed net.
    • Use Environmental Protection Agency (EPA) registered insect repellents with one of the following ingredients: DEET, picardicin, IR3535, oil of lemon eucalyptus or para-menthane-diol.
    • Do not spray repellent on skin under clothing.
    • If you are also using sunscreen, apply sunscreen before applying insect repellent.

Continue reading.